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Association between depressive symptoms and cardiovascular events in people with coronary heart disease largely due to physical inactivity

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QUESTION

Question:

Why is depression associated with an increased risk in cardiovascular events in people with stable coronary heart disease?

Population:

1017 outpatients (mean age 66 years) with coronary artery disease. Eligible participants were identified from administrative databases and had at least one of the following: a history of myocardial infarction, at least 50% stenosis in ⩾1 coronary vessel, evidence of exercise induced ischaemia, coronary revascularisation or diagnosis of coronary artery disease.

Setting:

Outpatient setting: Department of Veterans Affairs Medical Centres, university medical centres and public health clinics, California, USA; recruitment September 2000 to December 2002.

Prognostic factors:

Depressive symptoms (Patient Health Questionnaire (PHQ) and Computerised Diagnostic Interview Schedule for the DSM-IV (C DIS-IV)), smoking, alcohol use and medication adherence (self-report questionnaire), physical activity (self-reported exercise intensity and exercise treadmill test), demographics (age, gender, ethnicity, education), medical history (self-report), body mass index (physical measure of height and weight), biological mediators (heart rate variability, norepinephrine and cortisol excretion, blood serotonin, C reactive protein (CRP), blood omega-3 fatty acids, docosahexaenoic acid and eicosapentaenoic acid), use of other medications, cardiac disease severity.

Outcomes:

Cardiovascular events, including …

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